Mandibular Osteonecrosis due to the Pulpal-Periodontal Syndrome: a Case Report and Review of the Literature

Oral ulceration with bone sequestration: Retrospective study of eight cases and literature review

“…& Maxillofacial P., 2003;Sonnier & Horning, 1997;Villa & Gohel, 2014). In previous studies, ill-defined radiolucencies of the superficial alveolar ridge on periapical views (Almazrooa et al, 2010), cortex rupture (Carrard et al, 2009) or irregular radiopacities adjacent to the cortical bone on occlusal views (Peters et al, 2003(Peters et al, , 1993, and thinning of the cortical plate with signs of exfoliated bone sequestra on cone-beam computed tomographic scan (Gabric et al, 2017;Kharazmi et al, 2017;Villa & Gohel, 2014) have been described.…”

“…There is a clear preference of OUBS for the lingual mandibular mucosa covering the mylohyoid ridge, in particular the area of the internal oblique ridge. This predilection is depicted in the variety of topographic items used in the description of OUBS (Alkabouli et al, 2016;Dhanrajani, 2008;Gabric, Seiwerth, Baraba, & Vucicevic, 2017;Gündüz et al, 2010;Jackson & Malden, 2007;Kessler, 2005;Kharazmi et al, 2015;Peters et al, 1993;Villa & Gohel, 2014). Other reasons for this predilection, besides the prominence of the ridge, are a poor blood supply due to the distance of the lingual mandibular cortex from the intrabony alveolar arteries (Peters et al, 1993), susceptibility to trauma due to common loss of posterior teeth or their replacement by ill-fitting dental restorations, and an environment prone to microbial contamination due to limited cleansing of the lingual mandibular surface by the tongue (Carrard et al, 2009;Farah & Savage, 2003;Gündüz et al, 2010;Peters et al, 1993).…”

“…In most cases where a radiographic examination was performed, there was no abnormality (Alkabouli et al, 2016;Gabric et al, 2017;Gündüz et al, 2010;Jackson & Malden, 2007;Kharazmi et al, 2015;Peters et al, 1993;Peters, Daley, Academy, & of O. & Maxillofacial P., 2003;Sonnier & Horning, 1997;Villa & Gohel, 2014).…”

“…unintentional, such as excessive forces during mastication (Farah & Savage, 2003;Friel & Macintyre, 2002;Gabric et al, 2017;Peters et al, 1993), teeth brushing (Farah & Savage, 2003;Gabric et al, 2017) or bruxism (Carrard et al, 2009); or iatrogenic, for example, injury of the mucosa and periosteum during scaling (Scully, 2002), dental impression (Cerruto et al, 2018;Gündüz et al, 2010), traumatic placement of endotracheal tube for general anesthesia (Almazrooa et al, 2010;Kharazmi et al, 2015Kharazmi et al, , 2017 or teeth extraction (Alkabouli et al, 2016;Jackson & Malden, 2007). Sometimes, patients with OUBS recall a history of aphthous-like ulcers that might share common precipitating factors with OUBS, such as trauma (Friel & Macintyre, 2002;Scully, 2002;Sonnier & Horning, 1997).…”

“…The differential diagnosis of an intraoral ulcer above exposed bone includes various entities, such as MRONJ, osteoradionecrosis, congenital or acquired disorders, infectious diseases, or malignancies (Gabric et al, 2017;Gadiwalla & Patel, 2018;Villa & Gohel, 2014). In case of OUBS, the absence of any systemic factor known to induce osteonecrosis (Gadiwalla & Patel, 2018;Khan, Morrison, Hanley, et al, 2015b;Palla et al, 2016) and the presence of a well-demarcated, localized lesion (Fisher, 2010) in specific sites of bone prominences that heals soon after the sequestrum removal (Palla et al, 2016) are pathognomonic.…”